YOUR VULVA AND VAGINA MIGHT LOOK DIFFERENT AFTER GIVING BIRTH; HERE'S EXACTLY WHAT TO EXPECT

Despite an upswing in body positivity over the last several years, many people who've given birth still very much feel the pressure to "bounce back" fast. Often, that means to lose weight, but there are other ways snapback culture puts pressure on postpartum parents to look the same as they did prepregnancy. For instance, most parents notice differences in the vulva and vagina after birth - it's normal, even among those who didn't deliver vaginally. And too often, those changes can be a source of embarrassment, discomfort, and even shame.

That's partially because what happens to the vulva and vagina before and after birth isn't talked about as much as things like stretch marks or a loss of elasticity in the stomach. When they are talked about, all too often it's in the form of misinformed and, frankly, cruel jokes that center around the vagina getting "loose" after delivering a baby - a misogynistic myth.

So, it's crucial to talk about the short- and long-term changes to the vulva and vagina after giving birth. Knowing what to expect can preempt the insecurities that so many new parents end up confronting in silence. It can also be comforting. Many of the changes will reverse over time, notes Taraneh Shirazian, MD, a gynecologist at NYU Langone Health.

We asked Dr. Shirazian and other experts exactly how the vulva and vagina change after giving birth - aesthetically and otherwise - and got the details on what's temporary, what may not be, and what to do if you're feeling insecure.

The Vulva May Swell

After giving birth, the vulva becomes "hypervascularized, meaning there's a lot of blood flow to it," Dr. Shirazian says, adding that this can lead to engorgement. Swelling and soreness can also occur, causing the labia majora and minora to look puffy for about six to 10 weeks postpartum, she says. If it lasts longer, you can mention it to your doctor, but it should naturally subside, Dr. Shirazian adds.

The Labia May Look Darker

Higher levels of estrogen will lead to the labia darkening, and this is the case whether you've given birth via C-section or vaginal birth. This symptom should also fade within six to 10 weeks, Dr. Shirazian says.

You May Notice Vaginal Dryness

Changing estrogen levels are also linked to a reduction in your levels of natural vaginal lubrication, a side effect that should last about six to 12 weeks after giving birth, Dr. Shirazian says. Vaginal dryness affects everyone after delivery, regardless of whether you gave birth via C-section or vaginally, she adds.

This may sound like no big deal, but it can actually be relatively uncomfortable, causing itching or burning. It can also cause pain during intercourse, and people with more severe dryness may not be comfortable having vaginal intercourse at the six-week mark, which is when people usually get the green light to resume penetrative sex postpartum, she notes.

You May Be Healing From Tears

Approximately 70 percent of pregnant people will experience vaginal tearing when giving birth, according to a 2020 study in BMC Pregnancy and Childbirth. Less frequently - in about eight percent of births, according to the most recent findings - your doctor or midwife might make a small incision in the perineum (which connects the anus to the vaginal opening) to create more space for your baby to come through, a procedure called an episiotomy.

Both tears and episiotomies "are typically repaired with dissolvable sutures," explains Erin Conway, MD, FACOG, an obstetrician and gynecologist practicing in Red Bank, NJ. They can take up to 12 weeks to heal completely from, depending on the severity

But "in some cases, a scar may continue to cause discomfort with things such as sitting, wiping, or sex," says mom of two Laura Gleason, a physical therapist and the owner of Beyond the Bump Wellness. Dr. Conway says that up to eight percent of women self-report persistent perineal pain one year after delivery. If you're still experiencing discomfort more than 12 weeks after delivery, talk to your doctor.

Dr. Conway suggests asking specifically about scar massage, which "can promote elasticity of the area and improve pain," and pelvic-floor physical therapy.

Your Vulva Shape May Look Different

Just like your abdomen may not look the same after having a baby, your vulva shape might not look exactly the same either, Gleason says. Vaginal labor in particular stretches your tissue, which can cause aesthetic changes, especially if you deliver more than one child vaginally.

For instance, your labia might be elastic or appear more wrinkly. Or it may be longer or hang differently, causing the labia minor (inner lips) to show from the labia majora (outer lips) whereas before it didn't. One outer lip might appear bigger than the other, or your lips might seem permanently puffier than before, says Alexis Parcells, MD, a board-certified plastic surgeon and the founder of Sunnie Skincare.

"This is completely normal," Dr. Parcells emphasizes. "No part of our body is completely symmetric, and this is the case with the labia as well. This is nothing to be ashamed of or afraid of."

Gleason notes that aesthetic changes like this have a lot to do with genetics and how your tissue heals; the same reasons some people get stretch marks and loose skin on their abdomen after pregnancy and some don't.

Hormones may also play a role. Levels of the sex hormone estrogen dip after giving birth; breastfeeding keeps them low for about six months. Since estrogen plays a role in labial-tissue moisture and elasticity, once levels start to climb again, you may notice a change appearance too.

Your Vaginal Canal Will Likely change, Too

If you delivered vaginally, the vaginal canal will have stretched and lengthened, and afterward it might feel different, although not "looser" necessarily, Gleason says. In fact, some people feel more tightness or discomfort in the vagina postbirth, a symptom caused by the pelvic-floor muscles becoming overactive and too tense. These changes can affect how it feels to put in a tampon or have penetrative sex, she adds.

For the most part, the differences will be slight and not troublesome. But pelvic-floor physical therapy after birth is often a good idea, Gleason says, especially if you feel any pelvic muscle discomfort. (More on that later.)

Your Pelvic-Floor Muscles May Be Weaker

When you're pregnant, the fetus can put a lot of pressure on your pelvic-floor muscles, which support the bladder and vagina, and that can lead to weakness postpartum, says Mary Jacobson, MD, an obstetrician, gynecologist, and minimally invasive surgeon who is the chief medical officer at Alpha, a telemedicine practice for women. That weakness can lead to incontinence (leaking urine or, less commonly, feces).

"It is fairly common for people to have mild incontinence right after delivery, but that should resolve in the first four weeks," Gleason says. "If it is more severe or persists, that is when you should seek help." She suggests talking to your doctor if you experience symptoms like having to urinate all the time, not being able to fully empty your bladder, constipation, painful sex, pelvic pressure/prolapse, and pelvic pain.

"Sometimes I think our culture leads people to believe that we just have to deal with [incontinence], and that's kind of part of delivering a baby," says Gleason, who experienced incontinence after delivering her eldest child. But, she emphasizes, it's not normal - and pelvic-floor physical therapy can help.

When Does Your Vagina Go Back to "Normal" After Birth?

Dr. Shirazian suggests giving temporary changes, including swelling, dryness, or an episiotomy scar that needs to heal, six months. If they don't resolve by then, or if they're interfering with your daily life (as is the case for issues like incontinence), mention them to your doctor.

But when it comes to how long it takes for the vulva to totally heal and look like what it's going to look like, the time frame is about the same as it is for your stomach: a year or more, Dr. Shirazian says.

Ultimately, Dr. Shirazian recommends practicing self-compassion. "Be lenient on yourself and your body," she says. "If you have changes that persist and make you uncomfortable, let your doctor know, and ask about other therapies."

There are treatments to help with physical discomfort, such as pelvic-floor therapy, and even options meant to address aesthetic changes. While Dr. Shirazian warns against procedures that claim to tighten the vagina (which are largely unsafe), a labiaplasty, for instance, can safely reduce the size or change the shape of your labia. This can help with physical discomfort - if a lip chafes against clothing, for instance - or make people feel better cosmetically, Dr. Shirazian says. She suggests making sure to find a reputable surgeon who operates regularly, has done this surgery many times, and comes highly recommended by other patients.

"Also, keep in mind that if you're having more children, you may want to wait until your pregnancies are over to address the issue," she notes.

Regardless of what you decide is the best choice for you, Dr. Shirazian also emphasizes the usefulness of connecting with other people who've given birth, because many are going through the same thing: "You're not alone."

2023-03-20T14:29:07Z dg43tfdfdgfd